A nurse-led health literacy program at Loma Linda University Children’s Hospital reduced 30-day readmissions and improved caregiver satisfaction for pediatric heart surgery patients, a study in Critical Care Nurse reports.
A Targeted Approach to Discharge Education
Staff in the hospital’s 33-bed pediatric cardiothoracic intensive care unit (CTICU) developed the initiative described in “Out-the-Door, Dinosaur: Assessing Health Literacy to Improve Discharge Education,” to help patients recovering from complex congenital heart surgeries who require strict adherence to post-discharge care.
Nurses assessed caregiver health literacy within 24 hours of admission using the Newest Vital Sign, a validated tool that takes less than three minutes to administer and is available in English and Spanish.
The staff resource binder supported implementation and included scripts for administering the tool and guidance for documenting results in the electronic health record.
Addressing a Critical Gap in Caregiver Understanding
During the one-year implementation period from January 2023 to January 2024, 150 caregivers were screened. While 64 percent demonstrated adequate health literacy, more than one-third had limited or low literacy levels, highlighting an area for targeted intervention.
The care team responded by developing a tiered educational toolkit aligned with different literacy levels. They designed materials focused on pediatric open-heart surgery recovery to be clear and actionable.
Before discharge, nurses reviewed care instructions using the teach-back method to confirm understanding. Education is centered on five key areas:
- Medication administration
- Wound care
- Cardiopulmonary resuscitation (CPR)
- Nutrition
- When to seek additional medical care
Caregivers also received take-home materials that included visuals, such as pictures and drawings, to reinforce key concepts.
Measurable Improvements in Outcomes and Experience
The initiative was associated with a decline in 30-day readmission rates after cardiac surgical repair. The rate dropped from 12.3 percent (number of readmissions out of total cases not specified) in 2022 to 10.5 percent in 2023, representing a relative reduction over the first year of implementation.
Caregiver experience scores improved as a result. Follow-up telephone surveys conducted one week after discharge showed that responses indicating nurses explained care in an easy-to-understand way increased from 80 percent in the first quarter of 2023 to 100 percent by the fourth quarter.
Additional surveys during follow-up clinic visits reinforced these findings. All respondents reported confidence in performing required medical care tasks at home, and 93 percent said nurses explained procedures, medications, and care protocols clearly.
Empowering Nurses to Lead Equitable Care
Jennifer Newcombe, DNP, MSN, CNS-BC, CPNP-PC, AC, pediatric cardiothoracic nurse practitioner and co-author of the study, emphasized the role of nurses in advancing equitable care delivery.
“This initiative empowered bedside nurses to deliver equitable, patient- and family-centered care, meeting family caregivers where they are and providing education in a way they can easily understand,” she said. “Families are already anxious about caring for a child at home after heart surgery, and customizing discharge education based on health literacy levels can provide them additional confidence and comfort.”
